Hi Guest! Great questions: No you do not need to wait until the implant is placed to medical for the already rendered services – the extraction & bone graft. They each have their own codes! 🙂 As for the benefit breakdown – yes typically when a patient meets their out of pocket maximum, then coverage kicks in at 100% of the allowed amount of covered services (keep in mind – this is the insurer”s allowed amount, not necessarily your fee!) I am not quite sure what they meant by the implant not being broken up into three parts…..but yes there are CPT codes specifically for implants: 21248 – Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3 or less) 21249 – Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more) As for the diagnosis codes – this will depend on the reasons why the services are being done. For example, here are some common codes you may consider based on the situation you described: K08.21 – Minimal atrophy of the mandible K08.22 – Moderate atrophy of the mandible K08.23 – Severe atrophy of the mandible K08.24 – Minimal atrophy of maxilla K08.25 – Moderate atrophy of the maxilla K08.26 – Severe atrophy of the maxilla K12.2 – Cellulitis and abscess of mouth K04.6 – Periapical abscess with sinus K04.7 – Periapical abscess without sinus K04.1 – Necrosis of pulp K04.2 – Pulp degeneration K04.01 – Reversible pulpitis K04.02 – Irreversible pulpitis E10.630 – Type 1 diabetes mellitus with periodontal disease E11.630 – Type 2 diabetes mellitus with periodontal disease E09.630 – Drug or chemical induced diabetes mellitus with periodontal disease Hope this helps!
